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ABSTRACT: Superior labral anterior posterior tears have been described as symptomatic lesions in shoulders of patients of varying ages. It is unknown if age affects clinical outcome of arthroscopic fixation of type II superior labral anterior posterior repairs.
Clinical outcome of arthroscopic fixation of isolated type II superior labral anterior posterior tears differs between younger (<40 years) and older (> or =40 years) patients.
Cohort study; Level of evidence, 3.
Clinical results of arthroscopic fixation of isolated unstable type II superior labral anterior posterior repairs were compared between 25 patients younger than 40 years (group 1) and 25 patients aged 40 years or older (group 2). Patients with concomitant procedures, prior/subsequent shoulder surgeries, and use of non-suture anchor devices were excluded. Outcomes at a minimum 1-year follow-up were assessed using range of motion measurements and the American Shoulder and Elbow Surgeons questionnaire as compared with preoperative data. Ability and time to return to prior level of activity were assessed.
At a mean 3-year follow-up, there were statistically significant improvements in American Shoulder and Elbow Surgeons scores for both groups (P < .0001) but no significant difference between final American Shoulder and Elbow Surgeons scores (group 1, 91; group 2, 87; P > .198). Both groups demonstrated good or excellent results in >80% of patients. A traumatic mechanism of injury (P = .0346) and presence of osteoarthritis (P = .0401) were independent factors resulting in significantly lower postoperative scores. There were statistically significant differences in preoperative and postoperative range of motion for internal rotation (group 1, P = .0321) and forward elevation (group 2, P = .0003). Return to prior level of activity was similar between younger and older age groups: 80% versus 74%. Time to return to sport was prolonged for group 2 (11.0 months) compared with group 1 (8.45 months). Patients without osteoarthritis were significantly more likely to return to previous levels of activity than were those who had osteoarthritis (P = .0044).
Good to excellent results and high return to prior level of activity can be expected for the majority of properly indicated patients who undergo isolated type II superior labral anterior posterior repairs, regardless of age. Subtle deficits in range of motion were experienced by both age groups; this did not seem to affect final outcomes. The presence of osteoarthritis was associated with lower American Shoulder and Elbow Surgeons scores and inability to return to prior level of activity. Time to return to activity was prolonged for the older group.
The American journal of sports medicine 03/2009; 37(5):937-42. · 3.61 Impact Factor
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ABSTRACT: No fine-wire electromyography studies have been performed to compare the activity of forearm muscles in professional golfers versus amateur golfers.
The fine-wire electromyographic activity of forearm muscles differs between professional and amateur golfers during the different phases of the golf swing.
Controlled laboratory study.
Ten male right-handed amateur golfers and 10 male right-handed professional golfers without history of elbow symptoms were tested with fine-wire electromyographic electrodes inserted into the flexor carpi radialis, pronator teres, flexor carpi ulnaris, and extensor carpi radialis brevis muscles of both forearms. Electromyographic data were synchronized with video data, and the muscle activity was expressed as a percentage of maximum manual muscle test activity for each phase of the golf swing.
Compared with professional golfers, amateur golfers had more muscle activity in the pronator teres of the trail arm (right arm in a right-handed golfer) in the forward swing phase (120.9% maximum manual muscle test vs 57.4% maximum manual muscle test; P = .04) and a trend toward increased activity in the acceleration phase (104.8% maximum manual muscle test vs 53.1% maximum manual muscle test; P = .08). In contrast, professional golfers had more muscle activity in the pronator teres of the lead arm (left arm in a right-handed golfer) in the acceleration phase (88.1% maximum manual muscle test vs 36.3% maximum manual muscle test; P = .03) and a trend toward increased activity in the early follow-through phase (58.1% maximum manual muscle test vs 28.8% maximum manual muscle test; P = .06).
Pronator teres muscle activity in the golf swing differs significantly between professional and amateur golfers.
Exercises with an emphasis on stretching and strengthening of the pronator teres may be useful in treating and/or preventing medial epicondylitis in amateur golfers.
The American journal of sports medicine 12/2008; 37(2):396-401. · 3.61 Impact Factor
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ABSTRACT: Reestablishment of the native footprint during rotator cuff repair has been suggested as an important criterion for optimizing healing potential and fixation strength.
A double-row rotator cuff footprint repair will demonstrate superior biomechanical properties compared with a single-row repair.
Controlled laboratory study.
In 9 matched pairs of fresh-frozen cadaveric shoulders, the supraspinatus tendon from 1 shoulder was repaired with a double-row suture anchor technique: 2 medial anchors with horizontal mattress sutures and 2 lateral anchors with simple sutures. The tendon from the contralateral shoulder was repaired using a single lateral row of 2 anchors with simple sutures. Each specimen underwent cyclic loading from 10 to 180 N for 200 cycles, followed by tensile testing to failure. Gap formation and strain over the footprint area were measured using a video digitizing system; stiffness and failure load were determined from testing machine data.
Gap formation for the double-row repair was significantly smaller (P < .05) when compared with the single-row repair for the first cycle (1.67 +/- 0.75 mm vs 3.10 +/- 1.67 mm, respectively) and the last cycle (3.58 +/- 2.59 mm vs 7.64 +/- 3.74 mm, respectively). The initial strain over the footprint area for the double-row repair was nearly one third (P < .05) the strain of the single-row repair. Adding a medial row of anchors increased the stiffness of the repair by 46% and the ultimate failure load by 48% (P < .05).
Footprint reconstruction of the rotator cuff using a double-row repair improved initial strength and stiffness and decreased gap formation and strain over the footprint when compared with a single-row repair.
To achieve maximal initial fixation strength and minimal gap formation for rotator cuff repair, reconstructing the footprint attachment with 2 rows of suture anchors should be considered.
The American Journal of Sports Medicine 03/2006; 34(3):407-14. · 3.79 Impact Factor
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ABSTRACT: Suture anchor and bone tunnel fixations are used for distal biceps tendon repairs and have not been compared.
Suture anchor fixation is equal or superior to bone tunnel fixation.
Randomized controlled in vitro study.
A new fixation technique was compared to traditional bone tunnel fixation of distal biceps tendon ruptures between randomly selected sides of nine matched-pair, fresh-frozen elbow specimens from cadaveric donors (mean age = 74.7 years). Bone densities were determined. The distal biceps tendon was attached to the actuator of a servohydraulic load frame and loaded to tensile failure at a constant rate of 4 mm/sec. Bone density, sex, age, side, tuberosity area, repair, failure type, repair stiffness, and yield strength were compared.
Superior yield strength of suture anchor fixation (263 N) compared to bone tunnel fixation (203 N) (P = 0.0233) were demonstrated. When suture anchor fixation failure (1 of 9) occurred, the matched pair also failed.
Suture anchor fixation offers an equal if not superior alternative to bone tunnel fixation for repair of the distal biceps tendon in the specimens tested. Clinical Relevance: Suture anchor fixation may be used for distal biceps tendon repairs.
The American Journal of Sports Medicine 04/2004; 32(2):406-10. · 3.79 Impact Factor
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ABSTRACT: The purpose of the current study was to create a multidirectional glenohumeral instability model and compare anterior capsulolabral reconstruction with inferior capsular shift with respect to their effects on glenohumeral translation and rotational range of motion. Ten fresh frozen cadaveric shoulders were used with a custom shoulder translation testing jig. To create the multidirectional instability model the capsule was stretched an additional 20% from the initial rotational range of motion in apprehension and neutral positions. Shoulders were repaired using anterior capsulolabral reconstruction (n = 5) or an inferior capsular shift (n = 5). Anterior, posterior, inferior, and superior translations were measured along with the rotational range of motion for intact, stretched, and repaired conditions. All specimens showed increased translations and rotations after stretching. Both repair techniques significantly reduced anterior, posterior, and inferior translation. The inferior capsular shift was more effective in reducing inferior translation in the apprehension position; however, postoperative rotational range of motion was restricted significantly when compared with anterior capsulolabral reconstruction, and posterior subluxation of the humeral head was seen in all specimens. These results indicate that a vertical capsulorrhaphy with a medial to lateral shift of the glenohumeral capsule, as in the inferior capsular shift repair, significantly reduces rotational range of motion when compared in vitro with the horizontal shift of the anterior capsulolabral reconstruction.
Clinical Orthopaedics and Related Research 12/2003; · 2.53 Impact Factor
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ABSTRACT: This study compared muscle activity and timing of gait phases during functional activities in 13 subjects with patellofemoral pain associated with lateral subluxation and in 11 subjects with healthy knees. Fine wire electromyography recorded activity in the vastus lateralis and vastus medialis oblique during walking and ascending and descending stairs. Subjects were filmed to divide the activities into phases and determine timing. The vastus medialis oblique and vastus lateralis had similar patterns during all activities. Subjects with patellofemoral pain had significantly increased activity in the vastus medialis oblique and vastus lateralis compared with the healthy subjects during the most demanding phases of the gait cycle, suggesting a generalized quadriceps weakness in the patients with patellofemoral pain. Timing differences were seen in walking and stair ascending with the subjects with patellofemoral pain spending significantly more time in stance compared with the healthy subjects. This may be an attempt to reduce the load on weak quadriceps. These data reflect a generalized quadriceps muscle weakness, rather than the prevailing theory of quadriceps muscle imbalance as an etiology of patellofemoral pain. Therefore, we support the practice of strengthening the entire quadriceps muscle group, rather than attempting to specifically target the vastus medialis oblique.
Clinical Orthopaedics and Related Research 11/2003; · 2.53 Impact Factor
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ABSTRACT: Rupture of the distal biceps brachii tendon has most commonly been repaired by anatomic reattachment of the tendon to the radial tuberosity by a single- or two-incision approach. Researchers have studied suture anchor attachment through a single incision, but the tendon-suture interface and bone quality have not previously been analyzed.
Suture anchor repair results in stiffness and tensile strength equal to that of bone-tunnel repair for biceps tendon rupture.
Controlled laboratory study.
Twelve matched pairs of fresh-frozen cadaveric elbow specimens were used. Suture anchor and bone-tunnel tendon repairs were performed in a randomized fashion. Each specimen was loaded to tensile failure. Load-displacement graphs were generated to calculate repair stiffness, yield strength, and ultimate strength. Computed tomography bone density measurements and additional statistical analyses were then performed after grouping the specimens by mode of failure.
The bone-tunnel repair was found to be significantly stiffer in all cases and to have significantly greater tensile strength than the suture anchor repair in the younger, nonosteoporotic elbows.
Suture anchor repairs were not as stiff or strong as bone-tunnel repairs.
Biceps tendon surgery using the traditional two-incision technique yields a stronger and stiffer repair in the typical patient with this injury.
The American Journal of Sports Medicine 30(3):432-6. · 3.79 Impact Factor
